A congenital nasolacrimal mucocele, a lacrimal sac mucocele with intranasal extension, is an uncommon mass arising in the medial canthal region of the orbit. The authors describe four infants who presented with medial canthal masses and nasal airway obstruction. All underwent computed tomographic (CT) evaluation, which revealed the triad of cystic dilatation of the lacrimal sac, dilatation of the nasolacrimal duct, and an intranasal cystic mass. Appropriate therapy was determined following identification of the intranasal cystic component. Relevant discussions of the embryology, clinical presentation, and the characteristic CT findings of infants with congenital nasolacrimal mucoceles are included.